Provider Demographics
NPI:1811087828
Name:ROMAC, RONALD JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:ROMAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17926 HALSTED ST
Mailing Address - Street 2:SUITE3SW
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2029
Mailing Address - Country:US
Mailing Address - Phone:708-799-6677
Mailing Address - Fax:
Practice Address - Street 1:17926 HALSTED ST
Practice Address - Street 2:SUITE3SW
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2029
Practice Address - Country:US
Practice Address - Phone:708-799-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist